258 The Value Based Practice

Welcome to the KC CHIROpulse Podcast.  

This week’s topic:  Your Fee Strategy May Be Eliminating Your Value 

The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights.  This week, the show is hosted by Kats Consultants’ coaches Dr Michael Perusich and Dr Troy Fox, seasoned experts in Chiropractic business management.  This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.

In this episode, we discuss:

• How the patient’s perception of value is based on what you charge
• Why today’s patients need to feel a value proposition from you
• Why patients will drop-out of care if value is not properly conveyed
• Why outcomes should dictate your fee structure
• …and so much more…

In each episode of KC CHIROpulse, we delve into crucial aspects of building a successful Chiropractic practice, covering topics such as establishing a strong foundation, adopting a patient-centric approach, mastering marketing techniques, achieving financial fitness, fostering effective team building and leadership, integrating technology and innovation, and navigating common challenges in the field.

Whether you're a seasoned chiropractor or just starting your practice, the KC CHIROpulse Podcast offers a wealth of knowledge and personalized practical advice to help you navigate the intricate world of Chiropractic business. Join us on this journey as we explore proven strategies, share success stories, and connect with industry experts to empower you in your pursuit of building a thriving Chiropractic practice.

Don't miss out on the latest insights and expert guidance. Subscribe now and unlock the secrets to taking your Chiropractic practice to the next level. Your success is our priority at Kats Chiropractic Business Advisors.

DISCLAIMER:  The information presented in this broadcast is for educational purposes only and is not intended to offer legal, investment, accounting, or medical advice, and represents the opinions of the speakers.  Seek the consultation of a professional for advice in those areas. And remember…your results using this information may be different than described.

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Transcript

258 The Value Based Practice

Do Patients Value You

[00:00:00] 

Dr. Michael Perusich: Doctors, do patients value your practice? Hi, everybody. Welcome to the KC ChiroPulse podcast, brought to you by Kats Consultants and Chiro Health USA. We are your hosts. This is Dr. Troy Fox and I'm Dr. Michael Perusich. Welcome to the show today, Troy.

How are you? 

Dr. Troy Fox: I am fantastic. 

Dr. Michael Perusich: Good. Do patients value your practice? 

Dr. Troy Fox: They do, but I think it's in a different way than a lot of us as, as chiropractors see it. And I, I think this goes back to a business sense, but also goes back to our intuitive nature. Yep. And I, I think we have a problem where people see...

And think about it this way. 

Why Cheap Feels Low Value

Dr. Troy Fox: I'm gonna give you an example. So we're on Amazon, and you and I are shopping for an item for our office- Mm-hmm ... or we're shopping for an item for Kats. 

Dr. Michael Perusich: Right. 

Dr. Troy Fox: And we see three items. One is $23, one is [00:01:00] $57, and one is $13.99 with a 20% discount coupon. 

Dr. Michael Perusich: Ooh. 

Dr. Troy Fox: Which one do you think that you would think provided value for the, for the dollar amount?

Would it be probably the middle or the high one, right? Those are the two that you go, "Oh, those are probably pretty decent products." Yeah. How about the $13.99 one that's discounted 20%? Are you a little concerned that maybe it's shoddy quality, maybe there's something wrong with it, maybe it's substandard?

Dr. Michael Perusich: The manufacturer can't wait to get them all off their shelves. 

Dr. Troy Fox: Right. 

Dr. Michael Perusich: Yeah, so they do a fire sale. Yeah, cheap doesn't always equate to quality. And, it's interesting right now, you know, a lot of people feel like the economy, even though it's actually doing very well, a lot of peop- people feel like the economy's a little tight and those things.

And, and so the consumer has become very value-based. Mm-hmm. They still spend money. I mean, first quarter of this year, there was record retail spending, and yet everybody thinks [00:02:00] the economy's tight. So people are buying things, but they're buying things that have quality to them, not just cheap.

And unfortunately, we've had a rash of, uh, attempts to be cheap in the chiropractic profession in the last few years. And I, I won't name any names, and it, it doesn't really matter, but, but what we have to remember is that patients value care, and when they find value in your care, they will come and take, uh, and partake in your care.

If they find your care to be cheap, they will get the least amount out of it, even though your pricing might be low. This is why low pricing doesn't work. The- they'll get... The- they'll, they'll choose to not use it as often, and it's very counterintuitive. We, you know, we, we think, "Oh I can attract the patient in the door by being cheap," and then my treatment plans are cheaper than anybody's because my pricing is so low, [00:03:00] and we think that's going to increase utilization, and it just doesn't.

Dr. Troy Fox: No. What we typically see is that the patient comes in and assesses the value, and if you have a really low price for care, and you also have a great value for care, yes, they're gonna follow through with care, and they're gonna do well with it because- Mm-hmm ... it's the value, not the pricing. Now, if you price people out of the market, absolutely, that's a problem.

But if you're in range, but you're not trying to be the lowest on your block or in your town or wherever you're at- Right ... and you price accordingly, but you offer a good value for that service, that's where the patient walks through the door, and I'm gonna proffer that there are several things that they look at.

First Impressions Build Trust

Dr. Troy Fox: First, and I always like to use these three, when they walk in the front door, sight, smell, sound. 

Dr. Michael Perusich: Yep. 

Dr. Troy Fox: What do they see when they walk in the door? That's the first impression they get of your office. The second impression is gonna be that staff member that's up at the front that is welcoming that patient.

Dr. Michael Perusich: Mm-hmm. 

Dr. Troy Fox: Are they [00:04:00] well-versed in the practice? Do they know everything they need to know to answer questions? Are they able to take the patient and guide them through any processes they need to go through before they see you, the doctor? 

And that's, that's number one. Number two is that first visit with you.

When they come in to see you, are you kind, cordial, and warm? Are you in a hurry because you've been busy with other patients that day? 

Dr. Michael Perusich: Right. 

Dr. Troy Fox: Or do you take so much of their time that they're like, "Oh, my gosh. I gotta go pick up my kids." And so- it's a matter of being expeditious with the patient, but also listening to what the patient has to say.

Not cutting the patient off, hearing their story. But also, I think it's important if there's an intake in the practice, you've read that intake and you mention a couple of items that are maybe somewhat obscure on the intake so they know you read the intake. "Hey, I've read your intake. I saw blah blah blah and blah blah blah.

Tell me a little bit more about that." And get the patient engaged at that point. I know our biggest fear is the patient will start [00:05:00] talking and never stop, but if we allow the patient to express their concerns, because that's why they're there, right? 

Dr. Michael Perusich: Yep. 

Dr. Troy Fox: You think they're there for an adjustment. That is part of it, but what they wanna know is, do you understand their problem?

Long before they're gonna ask, "How long is it gonna take and what's it gonna cost," right? 

Dr. Michael Perusich: Yep. 

Dr. Troy Fox: And that's really how it works. 

Dr. Michael Perusich: That's how it works. That's exactly, exactly right. Um, we need to take a quick word from our sponsors, but we're talking about whether or not your practice is value-based and if you're value-centric with patients, because that's what they're looking for today.

So we'll be right back.

Speaker: Affordable care shouldn't mean undervaluing yourself, but most chiropractors are still undercharging, especially when it comes to insurance allowances and cash patients with limited coverage. Chiro Health USA helps chiropractors charge appropriately, get paid well when insurance is available and still serve patients with no or limited benefits.

All through a compliant [00:06:00] discount medical plan. The result, doctors stop undercharging, raise fees, and increase income by about 20% without sacrificing care. That's not a discount strategy. It's a business strategy. Learn more at chirohealthusa.com

Dr. Michael Perusich: Okay, everybody, welcome back to the KCChiroPulse podcast. We are talking about value and value-based, uh, consumers these days, and, uh, why having just cheap prices is probably working against you. 

Outcomes Retention Over Discounts

Dr. Michael Perusich: Part of that value base is, are you getting the right outcomes for, for your patients?

And you started kinda talking about that, Troy. 

Dr. Troy Fox: Yeah. 

Dr. Michael Perusich: And when I say the right outcomes, if you're trying to get pain abated with the patient, that's not the right outcome. It is an outcome, but it's not the right outcome. Patients come to us for the restoration of function most of the time, and so we have to find out what that function loss is in our patients.

And you know, I know every patient comes in and says, you know, "I've got 7 out of 10 [00:07:00] pain, back pain," or, "8 out of 10 neck pain," and, but that's not really their problem. It doesn't feel good, but when doesn't it feel good? It it doesn't feel good when I lay down and try to go to sleep. That's the functional component, is the sleep.

So we've gotta make sure that we're, we're attaching our care recommendations to those things. That's part of value. And then if we don't attach the right fee, and this is where it kinda gets a little counterintuitive, if we don't attach the right fee, then patients don't find value in it. Y- it's always kind of ironic when you hear people talk about the economy and, and I hear chiropractors say, oh, you know, "Oh, I gotta, we gotta keep our prices low so we can get patients access," and blah, blah, blah.

But go look in your parking lot. When your practice is full, step outside and look in your parking lot, and here's probably what you're gonna see. If you're in a rural community, you're gonna see some Denali trucks, some high-end Ram pickup trucks, and ni- those aren't cheap Those aren't [00:08:00] cheap. If you're in the city, you're gonna see Lexus, Mercedes, BMW, Lincoln.

Those aren't cheap. You're not seeing people drive around cheap cars because we all know cheap cars probably come with big mechanic bills. 

And they come with low status, and we're, we're all kinda status-driven. So chiropractic un- unfortunately has fallen off this cliff, it seems like, of everybody racing to the bottom.

And we see this all the time in our statistics. A lot of practices have no profitability on them. And so we've, we've gotta raise the bar on chiropractic care. You know, every- since the pandemic, everybody's looking for what we do. Mm-hmm. Why are we trying to drive low pricing? It just makes no sense. 

Dr. Troy Fox: And I'm gonna throw you a little nugget, too.

Even if your pricing is correct, the reason that a lot of patients don't see value in what you do is because your first visit is [00:09:00] fantastic. 

You do this phenomenal exam. You're talking to them. You're really engaging with them. You've got 15 minutes with them, 30 minutes with them, however long that exam takes.

If you're adjusting them on that day, you're also giving them an adjustment. They're getting a lot of care, and they're loving it, but there's no preemptive status at that point for that patient that's never been to a chiropractor before that, hey, the next visit looks a little different. The next visit, we've already done the exam.

We've already determined the course of care that we need to do. Now we just need to apply that care. That's not gonna take as long, so your visit with me will be shorter. You're still gonna get all the cool bells and whistles that you got this time, the adjustment. Maybe you're gonna get some STEM or some cold laser or some decompression or whatever.

Short conversation with that because a lot of times what we see is that second or third visit, the patient feels unimportant now. They walked in on day two assuming they were gonna do what they did on day one. 

Dr. Michael Perusich: Mm-hmm. It 

Dr. Troy Fox: didn't happen. 

Dr. Michael Perusich: Mm-hmm. 

Dr. Troy Fox: And they were in and out the door in three minutes, and they didn't say anything because they didn't know what to say.

Right. But they're [00:10:00] like, "Did something go wrong here? What? Why?" And then on, on the third visit, it happens again, and now all of a sudden the patient's questioning what they're doing. They're looking around going, "Okay, he's treating everybody else this way, too. Like, I was in the hot seat to go in the room," or, "I was in the waiting room waiting, and that next patient came out fairly quickly, but I don't understand it."

So wouldn't it be simple to create value with preemptive statements? 

Dr. Michael Perusich: Sure. Sure. You've always gotta stay ahead of the patient. 

Dr. Troy Fox: Absolutely. 

Dr. Michael Perusich: And, we're we see this trend with the, uh, with driving prices down, and, and we think we're creating more access, more accessibility for the patient, we're, we're making it more cost-effective for them.

But like your initial example in the pricing of the three different products the one with the discount coupon on it- doesn't have a lot of value in people's minds. They know it saves them money- Mm-hmm ... but here's the trap we get into as chiropractors. [00:11:00] We as a profession try to drive our practices by the number of new patients we see.

Mm-hmm. And how long is a new patient a new patient? One day. One day. One day is the only amount of time they are ever a new patient in your practice. 

Dr. Troy Fox: Man, I thought that was a trick question- ... so I wasn't 

Dr. Michael Perusich: gonna even answer it. It kinda sounds like one. But on day two, on day two they're not a new patient anymore.

Mm-hmm. They're an established patient. 

Dr. Troy Fox: Yeah. 

Dr. Michael Perusich: So i- if we d- are constantly focused on that, that one day is going to be the magic bean for the practice, like everybody thinks the new patient is the magic bean, but that patient's only a new patient for one day. So if we bring 'em in on a low price, have we set the stage that we have to keep pricing low then going forward?

And if it starts to change or starts to get confusing, what happens to that new patient that then became an established patient? Now they're a dropout patient. Mm-hmm. 

Dr. Troy Fox: And 

Dr. Michael Perusich: they're a gone [00:12:00] patient. And so that kind of practice with low pricing has a tendency to trip over itself because if we bring them in on that low price, and then on day two we start the actual treatment plan, and there's an adjustment and a couple of therapies, for example, now it's gonna be more expensive probably than day one.

Mm-hmm. And so here's where the confusion starts to come in. So we've gotta be careful about our pricing structure in our practices because it, it speaks to the value of what m- what you do if you let it. If people are too focused on the price, then that overshadows your outcomes and all those things. And, and you know, there was a big discount airline that just went under.

Mm-hmm. Um, they had to close the doors to this airline because they couldn't keep up on costs, and because consumers weren't finding good value even though they were cheaper. Even when [00:13:00] the airline industry consumer couldn't find value in their product, they stopped using it. So low price doesn't mean a bigger practice.

Low price doesn't mean more profit. Low price just might be a dangerous step to declining your practice. 

Dr. Troy Fox: Perceived value is much more important than price. 

Dr. Michael Perusich: Yep. Yep. 

Dr. Troy Fox: And we see that in some practices. You see some practices are just thriving, and it's like, "Why are they thriving?" And sometimes it's the type of services that they provide.

Be The Trusted Doctor

Dr. Troy Fox: And, you know, I'm gonna pose a question that I, I got asked this weekend, and I thought it was really interesting. This, this goes back to the value equation. What do medical doctors do? What do med- You tell me. What do medical doctors do? 

Dr. Michael Perusich: They do medical doctor-y stuff. 

Dr. Troy Fox: Okay, so they diagnose, right?

Dr. Michael Perusich: Yeah 

Dr. Troy Fox: And what do they, and then whether they prescribe after that 

Medication or a shot- Mm-hmm ... or they're gonna refer you out to another provider, right? 

Okay. And, and we rail- Or a clinic ... [00:14:00] and we rail on that sometimes as chiropractors. Oh, my gosh, look at them. That's all they do is give drugs and surgeries, right?

Let me ask you this question. What do you do as a chiropractor? 

Dr. Michael Perusich: All of that- Is, is your- ... but without, without drugs and surgery 

Dr. Troy Fox: Is your practice only the adjustment, though? Is it just next all day long, or are you looking for an opportunity to get those patients well? Are you looking for an opport- opportunity to change their life?

And so my challenge to you would be don't just be an adjuster. Be a natural health doctor. Be what we are as chiropractors, 'cause that's what really what we learn to be in school, right? 

We learn to be more than just an adjuster. We're chiropractors. Yeah. And so I look at that from a value standpoint, and that's why I think sometimes some of the practices that we see that are low-cost, single-service practices struggle a little bit because we don't see a perceived value in it.

I'm like, "Well, I can go in and get my back popped," right? 'Cause that's what patients will say. 

" I'm gonna get my back cracked down there, and he's [00:15:00] pretty cheap." But there's really not a perceived value in health and wellness. It's not like they're looking at any other product at that point. So I see a more complete product being more of who we are as chiropractors as well.

Dr. Michael Perusich: And I think that's a great point. I think that's a great point. You know, and if, if your patients are telling you they, they just popped in to get a good cracking, th- they're not getting it. They don't get the big picture. Mm. Patients should never say they're going to the chiropractor just to get cracked.

Dr. Troy Fox: Mm-hmm. 

Dr. Michael Perusich: Patients should be saying, "I'm going to the chiropractor to keep up with my wellness care." 

And that's the, you know, that's the long-term aspect of chiropractic care, and there's huge value to that. And so you don't win the game by being the cheapest on the street. You win the game by becoming the trusted doctor.

Because without trust, you can't build value, number one, and without trust, you don't create those long-term patients in your practice. And you're absolutely right, Troy. What we do as chiropractors goes way beyond an [00:16:00] adjustment. That is one piece of the puzzle. 

Dr. Troy Fox: And if you don't have the authority to tell the patient what they need and do it with a smile and have the patient listen to you, that's where you get back to the patient that just comes in for a good old cracking, right?

Dr. Michael Perusich: Yep. 

Dr. Troy Fox: Because they're, they're not really seeing you as the doctor that can help. They're not seeing you as the person that when they sprain their ankle, they call you first. 

They're just seeing you as the back guy or the back gal. 

Dr. Michael Perusich: Yeah. Yeah. 

Dr. Troy Fox: And I think that's where a lot of our value issue lies as well.

I think if you are not an authority, if you're not respected for what you do- And we struggle enough with that in chiropractic as it is, and I'm not saying it's our fault, 'cause I really don't think it is. I think there are a lot of forces behind the scene that don't help us a whole lot with that.

Mm-hmm. But we really have to work hard to become the respected authority as chiropractors. 

Dr. Michael Perusich: We do, and k- we've gotta stop putting ourselves out there as just the place where you go and get [00:17:00] a quick and cheap adjustment. There's way more to practice. There's way more to becoming value-based. There's way more to becoming the trusted doctor in your community than just creating an inexpensive, cheap adjustment.

Dr. Troy Fox: And I'm gonna give you a good example of that, that, that will make you think about this, the, the pressure that chiropractors have felt over the years. We all know it's been there. Mm-hmm. It's still there. It's just under the surface a little bit. I'm, you know, I'm, I'm not gonna hide that in a closet.

That's something that we deal with as chiropractors. But let me throw out an example here. You know, naturopaths weren't highly respected 20 years ago. 

Dr. Michael Perusich: Right. 

Dr. Troy Fox: What do people think of naturopaths now? Oh, my gosh, fantastic doctors. I wanna go to that person. I know it's expensive, but they have something really cool to offer.

You know, that's, that's what we hear from that from that side of things. 

Dr. Michael Perusich: Mm-hmm. 

Dr. Troy Fox: Now, here's the thing. They could [00:18:00] have, when they were not as well-respected and they were being talked down to by medicine, they could have discounted their prices, and they could have been a dime a dozen. They could have been- Yep

really cheap for care. They never did that. I don't know of any naturopath that did that. 

Dr. Michael Perusich: Right. 

Dr. Troy Fox: But yet we did. We've gotta get out of that trend. I look at it and I'm like, "I'm not sure how we get out of this barrel, but I think we need to get out of this barrel to create value for our services." It's not just us that's devaluing our own practice.

The profession is not helping itself. 

Dr. Michael Perusich: Yeah. And I, I- We have to value what we do ... 

Dr. Troy Fox: and I hate to say that, boys and girls, but it's so true, and if you guys sit back, and if you're not angry with me for saying it, and you actually listen to what we said, and you ponder it for a little while, you're gonna realize it's a, it, it's a profession-wide problem.

It's not a your practice problem only. Right. But you may be, you may be a part of it. 

Dr. Michael Perusich: Yeah, and we have to remember, too, we... L- just lowering [00:19:00] prices, while that may improve upfront accessibility, it's not the new patient that builds our practice. It's the retained patient that builds our practice, and w- when we, the further we get away from that patient being the new patient, the further we get away from that, the higher the risk of losing them- If we're not creating that value-based, wellness-based, uh, authority with patients.

And so if your retention is low, this is something to look at. What does your pricing structure look like? Is it too cheap? Is it overshadowing good outcomes? Are patients too focused on the money side? And again, this is where it's counterintuitive. You would think that the higher price, patients might question more, but they don't.

The person that buys the Mercedes is thinking, "Wow, my car is gonna last longer than the person who buys the Yugo." 

And [00:20:00] just by saying that, you probably agree with me. Because we have a perceived value indicator of what that Mercedes is like. It's high quality. It's built to last. What does your practice look like to patients?

Is your fee telling them that they can just come and go whenever they want? They can come in and just get a quick cracking? They can leave any time they want? Or does it say, "I'm proud to be a patient at this practice because I trust my doctor and I find value in what they do, and the outcomes overshadow the price"?

Dr. Troy Fox: And you said the key word, doctor, because, and I'm gonna throw this out here- 

Dr. Michael Perusich: Yep ... 

Dr. Troy Fox: I want you guys to go, I want you to get a piece of paper out today and I want you to write what are the benefits of an adjustment? Does it have value? Because if we devalue it, what is our patient gonna say? If it's just a good old cracking and that's all it is, does it have no effect on immunity?[00:21:00] 

Does it have no effect on the nervous system? Can you affect headaches? Can you affect gastrointestinal problems, bowel problems? Write down what the adjustment does- 

Dr. Michael Perusich: Yeah ... 

Dr. Troy Fox: and then value it accordingly. So when you look at it, you value that adjustment, no matter what value you place on it, but if you look at, if you look at it, and I'm just gonna give a, a, I'm gonna give the cheap example here, and I'm gonna say, "All right, I value my adjustment at $10, but I really believe in that $10 adjustment, and it's powerful."

You're gonna get more follow-through and more buy-in because you're bought in. Now, am I saying the adjustment's only worth 10 bucks? No, I was just using that as an example. But if I buy in at $48, and I say that adjustment is worth $48- Mm-hmm ... every day, all day long, and there's no doubt about it, and that's for a one to two region, folks.

Dr. Michael Perusich: Yep. 

Dr. Troy Fox: So if I buy into that and I realize the value of that adjustment, and I'm not [00:22:00] afraid to talk to patients about that, again, if my value of the adjustment is high, you're going to improve the value of your patients as well. So it's gotta come from you, doctors. It starts with you. That's the, that's the epicenter.

Dr. Michael Perusich: Exactly. All right, everybody. Creating a value-based practice. This is important. Being cheap is not a business model. So be careful how you structure your fees, but more importantly, be careful how you present value in your practice. We're gonna close out here with a quick word from our sponsors, but, uh, I just wanna thank everybody for attending the ChiroPulse podcast.

We're growing by leaps and bounds, and it's because you guys out there are tuning in every week. So make sure you like and subscribe, and, and share this with everybody in the profession. We're here to help you build profitable, ethical practices. We're here to help you work smarter, not harder in your practice, and to really enjoy being a chiropractor, and having a lifestyle that [00:23:00] goes along with that.

If we can help you out, go to katsconsultants.com and check out what we do and tune in with us anytime. So from all of us here at Kats Consultants, I wanna thank Chiro Health USA for being one of our sponsors. We'll see you guys next time. 

Dr. Troy Fox: We'll see you all later.

Speaker 4: Patient numbers, dipping staff overwhelmed, and another marketing idea, promising the world, but delivering nothing. These pressures feel familiar to nearly every Chiropractic clinic today across the country. Chiropractors work hard, yet many find themselves stuck. Balancing patient care with the nonstop demands of running a business.

That's where the real strain begins. Most clinics face the same set of hurdles, inconsistent new patient flow, operational bottlenecks, and the constant challenge of staying visible in an overcrowded digital space. National reports show that over 60% of clinics struggle with scheduling [00:24:00] efficiency alone and even more lack of clear marketing strategy that reliably converts.

But the good news, these challenges aren't roadblocks. They're signals with the right procedures, smarter outreach and guidance built specifically for Chiropractic practices, clinics can turn daily stress into sustainable growth. Stronger clinics start with smarter strategies. Grow your practice with confidence.

Book your strategy session with Kats Consultants.